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| considerations_postoperative = hemorrhage, wound infection, DVT, UTI, ureterointestinal leakage, ileus
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|Respiratory
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|Unique considerations
|Unique considerations
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|Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells
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|Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion
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|Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created.
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|Position
|Position
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|Supine, sometimes lithotomy for females
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|Supine
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|Supine, one or both arms out
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|Steep Trendelenburg
|Steep Trendelenburg

Latest revision as of 17:26, 4 April 2022

Cystectomy
Anesthesia type

General / Neuraxial

Airway

ETT

Lines and access

Partial: PIV x 1 (20)
Radical: PIV x 2 (18 or 16)

Monitors

Partial: Standard
Radical: Std + art line

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative

hemorrhage, wound infection, DVT, UTI, ureterointestinal leakage, ileus

Article quality
Editor rating
In development
User likes
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A cystectomy is the removal of all or part of the urinary bladder. Most commonly, this procedure is performed to address cancer.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • If spinal used, ensure T4 sensory level
    • Consider using epi in spinal to prolong block
  • Can consider placing epidural if significant post-op pain anticipated

Intraoperative management

Monitoring and access

  • 2 PIVs for open, radical, or robotic cystectomy (18g+)

Induction and airway management

  • GETA

Positioning

  • Supine
  • Sometimes females placed in lithotomy

Maintenance and surgical considerations

  • If radical cystectomy, have T&S and consider T&C 2 units
  • Some centers use indocyanine 25mg to visualize blood flow to the ureters

Emergence

Postoperative management

Disposition

  • PACU

Pain management

Potential complications

  • Bleeding

Procedure variants

Radical cystectomy Partial Cystectomy Open cystectomy Minimally invasive cystectomy Robotic cystectomy
Unique considerations Involves removal of entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells Possible when the cancerous lesion is located in the dome of the bladder. Does not require urinary diversion Simple, open cystectomy involves removal of the entire bladder without removal of any adjacent structures or organs. Urinary diversion is then created.
Position Supine, sometimes lithotomy for females Supine Supine, one or both arms out Steep Trendelenburg
Surgical time 4-6 hours ~ 2 hours (urinary diversion not required) ~ 4-6 hrs
EBL 300-1500 Minimal 1000mL 100-200mL
Postoperative disposition PACU
Pain management 2
Potential complications

References